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Sports Medicine & ShoulderSpecialist in Gilbert Arizona
Matthew L. Hansen, MD

Matthew L. Hansen, MD

Orthopedic surgeonBoard Certified in Orthopedic SurgeryBoard Certified in Sports Medicine

Hip Labrum

Labrum Debridement and Repair

Labrum Debridement

The hip joint, which is made up of a cup-shaped hip bone and ball-shaped thigh bone can move smoothly because of cushioning provided by the articular cartilage (tissue lining the surface of the hip and thigh bones) and labrum (tissue that surrounds the rim of the hip socket). The hip labrum has many functions, which include shock absorption, joint lubrication, pressure distribution, and maintaining hip stability. Thus, the labrum is a vital component of the hip, and any damage to it is a cause of serious concern, and requires medical attention. Damage to the labrum may take place in the form of a tear caused due to wear and tear, or injury as a result of repetitive twisting, pivoting and flexion motions at the hip.

Treatment usually involves labrum repair (securing the torn labrum in its normal position) or debridement (removing the labrum) depending on the nature of the tear. Labrum debridement is the removal of torn or weakened portions of the labrum that could get caught in the hip joint, and lead to pain and further damage.

Indications

Labrum debridement is indicated for labral tears that are most commonly seen in athletes who participate in sports such as ice hockey, golf, ballet and football. Surgery is also considered when conservative therapies like medications, injections and physical therapy cannot relieve pain. Labrum debridement is recommended for smaller and complex, highly macerated or degenerative tears, where the tissue seems to be shredded, and in older patients.

Pre-operative preparation

It is advisable to let your doctor know of any medications that you may be taking, so that they may decide on whether you can continue or stop taking them.

Procedure

Your leg will be placed in traction, i.e., your leg will be pulled away from the socket so that the surgeon is able to view the entire joint for performing the surgery. A button-hole sized puncture will be made in the hip to insert an arthroscope (small fiber-optic tube with a camera attached). Two to three more incisions are made to insert other surgical instruments. The surgeon will check whether it is possible to trim and reattach the torn labrum back to its original position. A motorized shaver is then used to smooth out and remove the shredded tissue. Only the torn tissue is removed, leaving behind the intact labrum. In case of small tears, your surgeon may use another device called electrothermal flex probe, which is run over the torn tissue to melt it, leaving behind healthy tissue. The incisions are then closed and bandaged.

Post op-care

The procedure is performed as an outpatient procedure; you will be discharged on the same day of the surgery. After the surgery, your doctor may prescribe antibiotics to prevent infections and medications to reduce pain and inflammation. You will be encouraged to elevate the leg to reduce swelling and inflammation. You may need to use crutches for 1 to 3 weeks, till you are able to bear weight on the operated side. You will be enrolled for physical therapy where you will be taught range of motion and strengthening exercises. It may take up to 6 months for you to fully recover.


Labrum Repair

Hip labrum is a cartilaginous membrane lining the socket of the hip joint. Labrum serves many functions where it acts as shock absorber, lubricates the joint, and distributes the pressure equally. It provides cushioning support to the joint. It also deepens the socket and helps to stabilize the joint. It holds the head of the femur in place and prevents the lateral and vertical movement of the femur head with in the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.

Labral tear of hip may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is one of the rare conditions and is common in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause hip labral tear. Patients may have hip pain, clicking and locking of joint and restricted range of motion. Patients may also experience dull pain on movement of hip joint that may not subside on rest. Hip labral tear is often diagnosed with symptoms, history, physical examination and radiological techniques. Magnetic resonance arthroscopy may be more appropriate for diagnosing hip labral tear.

Your doctor may start with conservative treatment prescribing nonsteroidal anti-inflammatory drugs and advising you to rest. These methods may offer symptomatic relief while surgery is required to repair the torn labrum. Your doctor may perform arthroscopic surgery using fiber-optic camera and surgical instruments through the smaller incisions. Depending on the severity of tear, the damaged or torn labrum may be removed or may be sutured.

Labrum repair is a surgical technique recommended for treating labrum tear. Labrum repair can be done using minimally invasive technique, open surgery or grafting. In arthroscopic surgery, the torn labrum will be reattached to the rim of the bone using anchor sutures and the capsules and ligaments will be tightened. In open surgery, the torn labrum will be removed and reattached to the joints using anchor sutures. In grafting technique, the torn labrum will be replaced by the labrum harvested from other bones of the body.

Labrum Reconstruction

The labrum is a ring of strong fibrocartilaginous tissue which lines the perimeter of the hip joint socket (acetabulum). The labrum serves many functions. It acts as a shock absorber, lubricates the hip joint, and distributes the pressure equally throughout the cartilage. The labrum holds the head of the femur in place and prevents the lateral and vertical movement of the femoral head within the joint. It also deepens the acetabular cavity and offers stability against femoral head translation.

Labral tears may be caused by trauma, femoroacetabular impingement (FAI), hip hypermobility, dysplasia, and degeneration. It is a rare condition that can be seen in athletes playing sports such as ice hockey, soccer, golf and ballet. Structural abnormalities may also cause a hip labral tear.

Patients with a labral tear of the hip may experience hip pain, clicking or locking of the joint and restricted range of motion. Patients may also experience dull pain on movement of the hip joint that may not subside on rest.

Hip labral tears are often diagnosed based on symptoms, history, physical examination and radiological techniques. Magnetic resonance arthrography may be more appropriate for diagnosing hip labral tear.

Your doctor will recommend conservative treatment initially prescribing nonsteroidal anti-inflammatory drugs, steroid injections and referral to physical therapy. These methods may offer symptomatic relief in a few weeks to months. If conservative treatment does not improve the pain then surgery is required to repair or reconstruct the torn labrum.

The goal of labrum reconstructive surgery is to restore the normal function of the labrum and prevent further damage to the cartilage.

Some of the surgical procedures include:

Arthroscopy:

Small incisions are made on the hip joint. An arthroscope is passed through one of the incisions. The arthroscope is an instrument that has tiny camera attached to the end. It enables the surgeon to view the area being operated on a bigger screen and also identifies the torn cartilage.

Depending on the severity of the tea, the torn section of labrum may be removed or the torn ends reattached and secured to the rim of the bone using small anchors.

Anchors are screw-like structures that have sutures attached. These anchors are placed on the torn labrum and the sutures are pulled tightly re-attaching the tissue to the bone. Later the incisions are closed using dissolvable sutures.

Open surgery:

Open surgery is performed in a similar way as arthroscopy but the torn labrum is treated by making a large incision over the hip area to access the joint.

Grafting:

Grafting is indicated in chronic cases where the labrum is so severely damaged that it is unable to be repaired. This is done using a graft taken from the patient (autograft) or from donor tissue (allograft). The grafts are stitched to the native labral margins.

Advantages of arthroscopy over open surgery:

  • Smaller incisions
  • Less bleeding
  • Less pain
  • Promotes faster healing

Post-operative care

The recovery following a hip labrum reconstruction will depend on the complexity of the surgery. Physical therapy is recommended as a part of a rehabilitation program which includes strengthening and stretching exercises to improve the function and movement of the joint.

Some of the possible complications associated with surgery include:

  • Joint stiffness
  • Recurrent pain
  • Infection at operated site
  • Bleeding
  • Nerve damage
AOSSM AAOS: American Academy of Orthopaedic Surgeons® / American Association of Orthopaedic Surgeons® ORS | Orthopaedic Research Society ARIZONA ORTHOPAEDIC SOCIETY OrthoArizona